Steps to Take to Avert a Serious Depressive Episode

There are those days or week when you feel the hot breath of the furies on your neck, and you feel the thunderheads building inside your skull. A serous depression is sweeping in on swift wings. You may feel like you can’t prevent it any more than you can ward off the weather or an act of God. There are certain positive steps that you can take, however.

1. Call your doctor and ask for an emergency appointment. If certain adjustments to your medication have helped in the past, mention them up over the phone. For me, an increase in my antidepressant may well do the trick; sometimes fiddling with my mood stabilizer helps.

2. Record your symptoms. Even if you’re not in the habit of keeping a journal or a mood log, it’s an excellent idea to start as soon as serious depression starts graying out your world. Different symptoms call for different remedies, and you are likely to be forgetful and to have trouble articulating your moods when you do get in to see your doctor.

3. Put people around you on the alert. Tell close friends and relatives what to look for, and ask them to record any symptoms they notice. You may sigh a lot, dig your nails into your upper arms, or stare out into space, and not realize that you’re doing it. Report these symptoms to your shrink along with the ones you record.

4. Try not to do anything that consistently depresses you: watching a lot of television, going to bed early and staring at the wall, overeating, procrastinating, shopping for crap you don’t need, and so forth. Diligently apply any techniques in your repertoire that help you to head off these behaviors.

5. Staring out into space feeling overwhelmed is my particular danger signal. When I catch myself doing it, I orient myself to the present by noticing five things that I see, five things that I hear, and five things that I feel. If following your breath works for you, do it. Then take one baby step towards completing a single task that is overwhelming you.

6. Try not to beat yourself up for feeling depressed. You know the routine: “I shouldn’t feel this way! I can’t afford to feel this way right now — I’m too busy! I can’t stand feeling this way again!” and so on. These thoughts can be just as depressing as the sensations themselves. Try very hard to feel compassion for yourself, and to acknowledge that your productivity may drop temporarily. Your productivity is not the measure of your worth as a human being. You can afford to ease up for a while.

7. To me, certain depressive episodes seem purely biological; I can’t find any logical tie between events and my mood. In fact, it annoys me when people ask me why I feel bad. I want to snap, “Because I’m bipolar, stupid!” Instead, I respond politely and follow my instincts by attacking my mood at the biological level. I make a conscious effort to eat regularly, attend yoga classes, and walk more at work. (My job requires an extraordinary amount of walking, and I have long flights of stairs both there and at home. This built-in exercise helps.) I increase my medication, as appropriate.

8. Conversely, I try to keep an open mind and acknowledge that there might be some cause that hasn’t fully percolated into my conscious mind. So I write down everything that’s bothering me and make it a priority to take a baby step on each problem. That way, if my depression is existential, I may be able to chip away at it.

I hope these suggestions help. The tough part isn’t knowing what to do; it’s putting that knowledge into action. For that, more than anything, I recommend baby steps and asking for help. If you feel like you can’t possibly call your psychiatrist, ask a friend or family member to do it for you (you may need to sign a release form in advance for them to be able to do anything other than make an appointment — doing that when you feel well is well worth the trouble).

As far as baby steps, set a timer and work for 15, 10, or even five minutes on a problem that’s bugging you. Exercise for five minutes. Spend 10 minutes brainstorming or researching solutions to your financial problems. Open the mail from that overflowing inbox for 15 minutes, and take action on one item that you find. You get the picture: Don’t expect too much from yourself, but keep moving forward.

Later today, if I get to it: A review of the excellent book The Burden of Sympathy, a study of the effects of caretaking on family members of a person with a mental illness.

Love to all.

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In his collection of essays On Aging, Holocaust survivor Jean Amery said that one must meet the phenomenon of aging -- inevitable yet terrifying -- with both revolt and resignation. So it is with mental illness. To deny that I will always be manic-depressive would be true madness; at the same time, I must revolt against my condition, rejecting the idea that it defines and limits me.